1. Field of the Invention
The present invention relates generally to medical devices and techniques, and more particularly to integrated point-of-care systems and methods for providing medical care to a patient.
2. Background Art
In modern medical health care facilities (i.e. doctors'offices, skilled nursing facilities, chronic care facilities, home care facilities, and hospitals), health care personnel use various medical devices to view patient information or provide medical care to a patient. Some medical care devices administer medical care—for example, an intravenous pump that delivers a solution containing a medication into a patient's bloodstream or a ventilator that delivers oxygen to a patient's lungs. Other medical monitoring devices measure and report a patient's physiological status—for example, an electrocardiograph (EKG) that measures and records electrical currents associated with heart contractions or a sphygmomanometer that measures blood pressure.
Typically, the patient is lying in a bed surrounded by various medical devices. In some cases, the medical devices are awkwardly and dangerously arranged around the patient's bed. The medical devices may hang from the ceiling, hang from bed rails, lie on the bed, sit on the floor, or sit on dedicated pedestals. The placement of these medical devices is often random and creates serious safety risks to the patient. There are also risks to health care personnel who attempt to carry or maneuver heavy devices in crowded quarters. Additionally, these medical devices have cords, wires, and tubes arranged in a tangled web that poses a safety risk. Also, many medical devices have their own display panel and control panel, which may be small (difficult to see), awkwardly located, space occupying, expensive, and redundant. Many medical devices include their own battery, which in addition to the extra control panels and read-out screens, takes up space and adds weight and expense. In certain rooms such as an intensive care unit, efficient organization of medical devices and utilization of space are even more critical due to the unstable, critical condition of the patient, number of devices, and the high cost of space.
In some circumstances, it may be necessary to transport medical devices along with a patient in order to sustain medical care during transport. In some prior art solutions, the medical devices are transported in a structure specifically designed for the medical devices, alongside, behind, in front of, or under the patient. This can be difficult and dangerous when passing through narrow spaces such as a crowded ward, doorway, or elevator. Also, separate structures for the medical devices require more medical personnel to transport the patient.
The nonstandard wires, tubes, and interfaces of the medical devices also pose a health and safety hazard to the patient and/or health care personnel during transport of the patient. Specifically, the medical devices may need to be detached from the patient and/or other medical devices prior to transport. Upon arrival at a different location, similar medical devices may need to be reattached. The processes of detaching and reattaching the medical devices to the patient are problematic for the health care personnel. Additionally, the array of wires, tubes, and interfaces may inadvertently detach from the patient or from each other during transport. Moreover, the medical devices may need to be connected to a portable power source during transport. Furthermore, the data generated by these devices is usually lost during transport as currently there is no one to transcribe it onto paper or input into the hospital's central data repository. A heavy device may fall during transport, jeopardizing the device, anyone in the way, and the back of anyone who tries to catch it.
Generally, the various medical devices surrounding a patient's bed operate independently of each other and include non-standard wires, tubes, and interfaces. One problem is lack of integration between the medical devices. For example, some medical devices generate information in a proprietary format, which is not compatible with other medical devices from different vendors. In another example, a medical device may produce an analog signal for a patient's vital signs. Because the signal is not digital or recorded, the analog signal must be transcribed onto a piece of paper or else the information is lost. As a result of this lack of integration, health care personnel must pay greater attention to control and monitor many medical devices individually—requiring more personnel to transcribe the data, more time to review the data, and greater potential for lost data and transcription error. Some devices with analog signals may store the data for short periods of time but again, the time must be taken later to review and transcribe the information.
Additionally, many medical devices operate independent of a health care computer system or an electronic medical record (EMR) in which a database of patient medical records is stored. Consequently, health care personnel need to read information from the medical devices and manually enter the information into the health care computer system for storage in the database. In one example, data from medical devices such as glucometers, EKG apparatuses, intravenous (IV) pumps, blood pressure monitoring, ventilators, and respiratory devices are not linked to the EMR. Manual transfer of information from the medical devices to the health care computer system is time-consuming and prone to error.
The aforementioned problems and inefficiencies with medical devices are of particular concern in intensive care units for neonates, children, and adults. In these environments, the patients are sicker; consequently, there is a greater volume of information per patient. Therefore, there is an even greater need to have an efficient point-of-care system to integrate, display, and control medical devices.
Current methods for communicating information about a patient often involves paper which can be lost or difficult to access, particularly when this information may be generated in different parts of a medical care facility but still pertains to the same patient. For example, there may be information from a blood-testing laboratory, a radiology facility, a specialist's visit, a nursing assessment, and an operating room or procedural facility. It is also not searchable electronically nor easily graphed—the comparison of current and prior data requires a lengthy search through multiple sheets of paper for comparison.
Verbal and hand-written orders are prone to error, due to confusion about what was said, difficulty interpreting handwriting, and multiple manual steps required to translate the idea into action. Point of care devices and systems used to replace them tend to be time-consuming because of unwieldy software, the small screen geography offered by many devices, and a lack of decision support.
Avoidance of adverse drug events and enhancement of decision-making is best provided at the point of care by devices and systems which can interact patient—specifically with the pharmacy, EMR, laboratory, picture archiving and communication system (PACS) and devices which measure important patient parameters, such as weight, blood pressure, pulse or respiratory rate. This includes the ability to read barcodes, passwords, magnetic badges, and other biometric or radiofrequency information about patients, health providers, and medications.
As some health facilities close and others become busier, facility administrators need better real-time information on bed-use to safely and efficiently run at higher rates of bed utilization. Currently this information is obtained by phone calls, estimates, and verbal reports of bed occupancy and anticipated discharges. It is therefore inaccurate, awkward to collect, and usually late. Also, medical facility administrators do not have an accurate tally of the number of devices used by an individual patient (therefore they can not charge for them), or the number of devices used aggregately by all their patients, or the devices which are unused on one floor but may be needed on another. If a device breaks or malfunctions, it may be complicated to remove and replace it because of the snarl of tubes and wires in which the device may be entrapped.
Insurance agencies would prefer better information on the care of their patients—and some of this information is not currently collected. These agencies would like to define the variables they believe determine quality of care and ask health facilities to report them. These agencies would like real-time information about patient care in order to approve or deny treatment in a timely manner and to know their expenses. The insurance agencies would also like real-time information provided in digital format in order to streamline and diminish the cost of billings and collections.
One prior solution for neonatal care is Ohmeda Medical Division's Giraffe™ OmniBed™. The OmniBed is a neonatal care station that includes a warmer and incubator in a mobile environment. The OmniBed converts between a closed incubator and an open bed, thus reducing the need to move the infant from one type of bed to another and facilitating transport.
The approach of some is to display patient information at towers or stands or nursing stations or consoles near a bed, or sliding devices that attach to the bed. These methods have significant degrees of ambiguity and carry the risk that information or orders intended for one patient are applied to another patient nearby because the device is not unambiguously specific to (and cognizant of) one patient.
While prior approaches to improving patient care have had limited success in some circumstances, further improvement is needed in light of the aforementioned problems and inefficiencies with point-of-care medical devices. In particular, there exists a need to integrate point-of-care medical devices and to facilitate transport of the medical devices along with a patient.